Provider Demographics
NPI:1366280331
Name:MADGETT, ERIC BRYSON (PHARMD)
Entity type:Individual
Prefix:DR
First Name:ERIC
Middle Name:BRYSON
Last Name:MADGETT
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:894 ASTERFIELD LN
Mailing Address - Street 2:
Mailing Address - City:DELAND
Mailing Address - State:FL
Mailing Address - Zip Code:32720-2340
Mailing Address - Country:US
Mailing Address - Phone:386-843-2503
Mailing Address - Fax:
Practice Address - Street 1:3821 S NOVA RD
Practice Address - Street 2:
Practice Address - City:PORT ORANGE
Practice Address - State:FL
Practice Address - Zip Code:32127-4950
Practice Address - Country:US
Practice Address - Phone:386-788-2220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-16
Last Update Date:2024-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL67265183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist